Home Referral Guidelines Laboratory Services
FSH testing Print E-mail

UNDERSTANDING AND UNDERTAKING FSH ASSAYS

FOR DIAGNOSING MENOPAUSE AND

ASSESSING PERIMENOPAUSAL CONTRACEPTIVE NEEDS

Practice Points:

  • MENOPAUSE – measurement of FSH is rarely necessary in women who clearly have menopausal symptoms and are within the normal menopausal age range. (See algorithm 1 overleaf)
  • CONTRACEPTIONA single raised FSH should not be used as a guide to stopping contraception immediately;   two FSH measurements of >30 U/L,    6 weeks apart are required. Some women may continue to ovulate after a raised FSH level (see algorithm 2&3 overleaf)

Pre- and postmenopausal hormone levels:

Adult women 

Oestradiol  pmol/l

 FSH   U/L     

LH  U/L

Early Follicular                 

75-140                        

 3.0–10.0                     

2.5 – 9.0

Midcycle                          

550- 2095                   

usually<30                 

<90

Luteal                                         

370-770                      

1.5 - 9.1                      

1.5 - 9.0

Perimenopausal            

Variable                    

Often > 15                

Variable

Post-menopausal         

<150                           

> 30*                          

>20

(These ranges may vary slightly between laboratories due to methodological differences)

* Note that a patient with a FSH of >30 U/L cannot be regarded as post-menopausal until periods have ceased for at least 1 year

 

If you wish to measure FSH:

  • Consider whether the result will actually help your clinical management.
  • Provide the laboratory with the LMP, clinical details and information regarding any contraceptive medication. If the woman is having periods take sample on Day 1-5 of cycle.
  • FSH >15 U/L on Day 1-5 of cycle is suggestive but not diagnostic of ovarian failure or perimenopause.
  • Random FSH >30 U/L is highly suggestive of ovarian failure or perimenopause but could represent mid-cycle peak especially if LH concentration is greater than FSH. 
  • Ovarian failure and perimenopause cannot be excluded by normal FSH levels as hormone levels fluctuate markedly in perimenopause.
  • For women with aged < 45 who are not on OCP and have amenorrhoea or menstrual irregularity , the laboratory may add additional tests (eg prolactin) if FSH is within the reference range

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Reference

Faculty of Sexual and Reproductive Healthcare Clinical Guidance May 2010 Contraception for women aged over 40 years.

http://www.ffprhc.org.uk/admin/uploads/ContraceptionOver40July10.pdf

  • Dr Ailsa E Gebbie, Lothian Sexual and Reproductive Health Service
  • Dr Geoff Beckett, Clinical Biochemistry, Royal Infirmary of Edinburgh, NHS Lothian

September 2010

Last Updated on Friday, 14 January 2011 16:11
 
 

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